Provider Demographics
NPI:1972018299
Name:JEFFREY FLORES DDS INC.
Entity Type:Organization
Organization Name:JEFFREY FLORES DDS INC.
Other - Org Name:RANCHO DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:VALDEZ
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-682-7378
Mailing Address - Street 1:65 ADELFA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1284
Mailing Address - Country:US
Mailing Address - Phone:858-733-2279
Mailing Address - Fax:
Practice Address - Street 1:28261 MARGUERITE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3703
Practice Address - Country:US
Practice Address - Phone:949-682-7378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58512122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801026919Medicaid